Investing in a dedicated lay staff to facilitate admissions and discharges across care settings can lead to meaningful improvements in healthcare utilization and quality, and in the overall patient experience, according to results from a pilot program presented by Mark Liu, MHA, at the 2020 ASCO Quality Care Symposium.
Members of this lay staff, called oncology coordinators (OCs), contributed to reductions in 7- and 30-day readmissions and time to chemotherapy administration, and led to improvements in discharges before noon and the patient experience overall, reported Mr Liu, from Mount Sinai Hospital.
Pilot Study Background
The Mount Sinai Health System is an integrated healthcare delivery system consisting of 8 hospitals spread across all 5 boroughs of New York City. According to Mr Liu, patients with cancer are frequently admitted to Mount Sinai, requiring medical oncologists to take an active role in coordinating with multiple care teams.
In an effort to redesign care with a focus on placing patients at the center and addressing the increasing demands on medical oncologists’ time, Mr Liu and colleagues created the OC role, focused specifically on care-setting transitions. In this pilot program, they aimed to evaluate whether these newly created roles would improve quality of care while decreasing healthcare utilization.
OCs were defined as nonclinical liaisons who serve as a single point of contact for disease-based teams as patients prepare for elective admission or discharge from the hospital. “So they think about these care transitions 100% of the time,” he noted.
In the pilot study, 3 OCs received specialized training in both systems and processes in the inpatient and outpatient settings. They were responsible for coordinating outpatient appointments, facilitating prescription delivery (whether at the patient’s bedside or at home), and coordinating transportation, all while providing clinical support to the clinicians involved.
The OCs were also responsible for facilitating 2 interdisciplinary rounds per day across 3 dedicated oncology inpatient units and assisting if patients were admitted off-unit (ie, the medicine unit). They worked through an Epic-based checklist to ensure a smooth patient experience between care settings.
“During these kinds of critical care transitions, we’re probably all too familiar with the quality metrics that are tied to these measures, whether they be length of stay, excess days, readmissions, or discharges before noon,” said Mr Liu. “There’s a lot that goes into ensuring these care transitions go smoothly for our patients, caregivers, clinicians, and the hospital.”
He and his team compared all patient discharges facilitated by the OCs versus non–OC-facilitated discharges between January 1, 2019, and March 31, 2020. They evaluated 7- and 30-day readmissions, rate of discharges before noon and average time from admission to chemotherapy administration, and measured the patient experience through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.
OCs Led to Significant Improvements
The findings were encouraging; the researchers saw a 5.5% improvement in the average rate of discharges before noon with OC facilitation.
“We also saw reductions in 7-day (–5.01%) and 30-day (–0.13%) readmissions,” he said. “And from the process improvement side, we saw that the OCs were able to remove some barriers and streamline some processes to really improve the overall time to administration for our elective chemotherapy admissions (–8.38%).”
Mr Liu noted that the COVID-19 pandemic hit New York City hard right around the end of the pilot program measurement period, so looking only at data from January 2019 through January 2020, the improvements seen with OCs were even more impactful, specifically in regard to percentage change in readmission rates.
“[During that period] we saw about a 31% improvement in 7-day readmissions for the discharges that were facilitated by the OCs, and about an 8% reduction in 30-day admissions,” he said. “This was really encouraging to see.”
HCAHPS surveys also revealed promising results in regard to the patient experience overall, with improvements seen over time for care transitions as well as for discharge information provided to patients. Mr Liu noted that the latter metric was most improved in the inpatient units where the OCs were most active.
Future work for Mr Liu and colleagues will focus on evaluating the sustainability of this program, as well as its association with other healthcare costs.